Doctor Patient Relations

Aim for Patient Adherence Rather than Compliance

By Brian Chou, OD, FAAO

One of my neighbors, Dian, a pleasant lady in her 60s, shared with me her recent experience visiting her dentist. Dian recounted that at her last visit, her dentist finished the periodontal exam, picked up her dental insurance card, glanced at it and then looked her straight in the eye and deadpanned, “You need orthodontics.” She found this peculiar because after years of her dentist not broaching the subject, he suddenly proposed orthodontics! Her new dental plan provided an allowance for orthodontics, so it was unlikely that her dentist’s recommendation was purely coincidental. In essence, her dentist was chasing the dollar, even though orthodontics was not something Dian felt was necessary or even wanted. Dian rightly surmised that her dentist was putting his own financial interests over what was best for her.

Years ago, patients like Dian may not have questioned their doctor’s motivations. The doctor’s word was gospel, as if it was a directive from God. Every patient wanted to be “good” and comply. If you did not, you were a social deviant. Today, the doctor is no longer the sole source of information. Instead, patients get information from online sources, including ratings and review web sites. Manufacturer advertisements and social media also provide information that compete and sometimes run contrary to what the doctor directs.

In optometry we can see a similar evolution when patients come to the office requesting a branded direct-to-consumer advertised contact lens, say Acuvue or a particular eye-color changing contact lens. These patients come into the office asking for these specific products, and they typically don’t care so much about which doctor is prescribing them. In these cases, the doctor’s expertise is trivialized. In contrast, in a patient-doctor relationship the ideal situation is where the product reinforces the bond. A good example would be a specialty hybrid multifocal contact lens.

Patients don’t typically come in asking for such a lens, yet practitioners can exercise their expertise to determine patient cases where this can benefit the patient, and the successful treatment outcome only solidifies the patient’s trust in the doctor. Another way of saying it is that in the former example, the patient gives credit to the brand of contact lens, whereas in the latter case, the patient gives credit to the doctor’s expertise. For optometry to be a sustainable endeavor, the profession needs to support vendors that strengthen the patient-doctor relationship, not only so that we can charge for services, but also to facilitate a patient adherence that is built around trust.

Understandably, the existence of health care professionals that breach their fiduciary responsibility of putting patient care ahead of financial interests has also turned the consumer sentiment toward verifying their doctors before trusting them. We cannot completely blame practitioners that turn to the “dark side.” Greater competition from all directions in our industry–from online product fulfillment, economic turbulence, an increasing supply of new optometrists without paralleled demand and decreasing and stagnated third party reimbursements–all lead more of our colleagues to listen to practice management consultants who exhort practitioners to wield their prescriptive authority to promote profitable products and services in a self-serving manner. The more practitioners who embrace selling the trivial and unneeded, the more consumers who will flock to the internet where they seek greater transparency.

By accepting that our patients no longer view us as the squeaky clean stalwarts of yesteryear, we can move beyond the compliance conundrum. Adherence is more apropos for today, because it describes the patient and doctor together working toward the shared goal of the patient’s betterment. In comparison, compliance is a unilateral demand where there is unequal footing because the patient is inferior to the doctor. With adherence, there is bi-directional communication without dominance and subordination in the relationship.

Personally, I cannot adopt some of the techniques that these high-priced practice consultants promote, because they are outside my comfort zone of good ethics. Often times, I find that these consultants assume the old style compliance paradigm where the doctor commands the patient to adopt the new product or treatment without reasonable justification. That is why I will not partake in elevating a normal finding to the level of serious disease just to sell something. The most sophisticated and enlightened vendors recognize that they must support our ability to serve our patients’ inherent needs and not simply drive patients to our offices to demand their product. In other words, vendors that strengthen the patient-doctor relationship, not the patient-product relationship, should earn our support because the adherence paradigm is the one that most recognizes our value.

What are some of the ways you work together with patients to achieve a shared goal that improves their eye health and vision?

Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.

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